Monday, 4 April 2011

Hands off our NHS...and why Ed might be right...

Was today the new beginning? For the first time in SO long, I cheered when I heard a Labour leader's speech. He put forward some decent ideas, argued very well against the government, and made ideological and sensible arguments against a policy. Merci Dieu. 'Red Ed' no longer... for this seemed like a man on a mission, and a man whose mission was to appeal to the country, not just the unions (cf CULC blog today) - a man taking Labour in the right direction.

And what was he arguing against? Possibly one of the most rushed, potentially damaging, and unnecessary changes to one of our public services in living memory (or indeed ever) - and one that this government promised wouldn't be on the cards before the last election. No major top-down shake up of the NHS - what a pile of rubbish. An NHS for the patients? Again, what a pile of old tut.

I had the honour of going to the BMA Medical Students Conference this last weekend, and joined my voice to hundreds, if not thousands, of health professionals and service users by speaking against and condemning the appalling changes envisaged by the government bill (which has now been 'stalled' to allow Andrew Lansley the time to explain it further).

Let me outline the big four problems:

1. GP consortia - yes, of course there should be input from medical professionals in the delivery of care, but that doesn't mean smashing the PCTs or making a bunch of managers redundant simply to make yourself look like an effective government. Of course, a load of the middle managers (the ones the government wants to get rid of) will simply end up working for the consortia rather than the PCTs, hence leading to the removal of high-level managers, the ones with the expertise. Do GPs really have the skills and time to manage health care resources? Do they really want to? Why is there no involvement AT ALL of those working in secondary and tertiary care - those actually employed by the NHS - but rather total monopoly given to those who have a very different contract structure? We should be using all clinicians to inform resource provision, and we should also be using patient groups and government. This is a huge fudge. And another problem - take for example the patient who has a series of severe headaches, and whose GP refuses to grant an MRI scan. That patient has every reason to turn to his doctor and ask her why - and ask her whether it's about saving money. And what could she say to that? I'm all for having input, but there has to be managerial input at least at some level. Chucking out all the managers (and there are indeed arguably far too many at the moment) is simply not the answer, is ideological, gets cheap points, and is dangerous. Patients, our patients, will suffer. Look instead at the managers in hospitals who are employed to order a consultant's materials - which that consultant could do by themselves (and who did a few years ago), and rationalise there, rather than making sweeping and idiotic changes to the provision of the whole of healthcare.

2. The lie about competition - at the BMA, I heard the argument go like this: we are all medical students competing for jobs. Therefore, competition is good for patients, so stop moaning about competition between the NHS and private companies for provision of services. Simplistic? Just a little. What a load of rubbish. The difference is that competition between people for jobs, meaning the best and most qualified is likely to get the job, is good for patients. But once price becomes an issue, then quality will suffer. Fact. The government has announced that value for money will be considered by Monitor (the new watchdog) rather than simply cost, as a carrot to those appalled by the plans. Sorry? That wasn't the original intention? How can competition be anything other than dangerous if quality is not the first criterion? Put it like this: would you like a hip replacement with cheap material and labour that will last for 5 years but have quarter of the cost of one that will last for 15 years? It's value for money, it's just you'll need three in the time. If you believe that healthcare is one of the things that should be equally given to all (like education, for example), then competition is not a good thing. Why not spend the time looking at how to provide NHS treatment better, or rolling out limited competition for specific purposes? We are primarily a caring profession - caring for patients. Giving them worse options to save money simply isn't ethical. That's not to say that we can continue spending what we do (or increasing spending) on healthcare - indeed, it is thought that if we continue to increase spending like we have for the last 10 years, then we will be at 100% of GDP spent on healthcare in the not too distant future. So what we need is a rationalisation, a bottom-up decided, and then top-down implemented system, to determine what we should, can and will pay for, and how best to achieve that within the NHS.

3. Cherrypicking - arguments abound on this - suffice to say that private companies taking the cheap and profitable operations, leaving the costly and complicated ones to the NHS, will lead to the destruction of the fabric of the NHS, making it even less sustainable. Which isn't what the Tories want to do, of course...

4. The national NHS - postcode lotteries are despicable. Utterly so, and it is a failure of the last government not to have destroyed them. Devolution aside (and I'm not a huge fan of it), if we believe in a national service which provides free health care at the point of use, that is what we should provide. We don't. We provide localised health-care, so 'local people can have a voice on what their priorities are'. This is NOT a NATIONAL health service, and devolving power from national to local government in this area does two things. Firstly, it removes the blame from the Dept of Health - so when the inevitable goes wrong, they can sit back and say 'not us gov'nor'. And secondly, it further cements localism which is damaging to a national health service. In this area, like in education, we need nationwide priorities, and nationwide services that are available. If someone in Surrey can get IVF on the NHS (or any number of other treatment), then someone in West Yorkshire should be able to as well. It's not fair, it's not popular, and it's not something we should countenance any longer. Taking it to extreme - if loads of people have heart attacks in Hampshire, but few in Cambridgeshire, should you be prevented from life-saving treatment simply because you live in the latter? Of course not. So anything provided by the NHS should be exactly the same.

These reforms (if that's really what they are) are a disaster, and in the words of the BMA, we should be going for evolution, not revolution. Ed Miliband struck the nail on the head today, and I hope this is characteristic of what is to come from the Labour opposition. He suggested a cross-party think on the NHS - one badly needed and well overdue - and I just hope he is taken up on it. These reforms are a disaster, they are not popular with the public or the health service, and we need to stop them. Otherwise patients will suffer, and then why bother having an NHS at all?